oppN66001-17-S-3601-cfda12.335-cidRA001.pdf

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Research & Related Budget

Information Analysis, Inc.

D:20061211100028- 05'00'

D:20061211100028- 05'00'

Budget Type:

Enter name of Organization:

Start Date:

End Date:

ORGANIZATIONAL DUNS:

Budget Type is required.

Budget Type is required.

OMB Number: 4040-0001

Expiration Date: 10/31/2019

A. Senior/Key Person

Prefix

First

Middle

Last

Suffix

Base Salary ($)

Months

Cal.

Acad.

Sum.

Requested

Salary ($)

Fringe

Benefits ($)

Funds

Requested ($)

Project Role:

Additional Senior Key Persons:

Total Funds requested for all Senior Key Persons in the attached file

Total Senior/Key Person

B. Other Personnel

Number of

Personnel

Project Role

Funds

Requested ($)

Fringe

Benefits ($)

Requested

Salary ($)

Sum.

Acad.

Cal.

Months

Post Doctoral Associates

Graduate Students

Undergraduate Students

Secretarial/Clerical

Total Number Other Personnel

Total Other Personnel

Total Salary, Wages and Fringe Benefits (A+B)

C. Equipment Description

List items and dollar amount for each item exceeding $5,000

Equipment item

Funds Requested ($)

Total funds requested for all equipment listed in the attached file

Total Equipment

Additional Equipment:

D. Travel

Domestic Travel Costs ( Incl. Canada, Mexico and U.S. Possessions)

1.

Foreign Travel Costs

2.

Total Travel Cost

Funds Requested ($)

E. Participant/Trainee Support Costs

Tuition/Fees/Health Insurance

1.

Stipends

2.

Travel

3.

Subsistence

4.

Other

5.

Funds Requested ($)

Number of Participants/Trainees

Total Participant/Trainee Support Costs

F. Other Direct Costs

Funds Requested ($)

1.

Materials and Supplies

2.

Publication Costs

3.

Consultant Services

4.

ADP/Computer Services

5.

Subawards/Consortium/Contractual Costs

6.

Equipment or Facility Rental/User Fees

7.

Alterations and Renovations

8.

9.

10.

Total Other Direct Costs

G. Direct Costs

Funds Requested ($)

Total Direct Costs (A thru F)

H. Indirect Costs

Indirect Cost Type

Indirect Cost Rate (%)

Indirect Cost Base ($)

Funds Requested ($)

Total Indirect Costs

Cognizant Federal Agency

(Agency Name, POC Name, and POC Phone Number)

I. Total Direct and Indirect Costs

Funds Requested ($)

Total Direct and Indirect Institutional Costs (G + H)

J. Fee

Funds Requested ($)

K. Total Costs and Fee

Funds Requested ($)

Total Costs and Fee (I + J)

L. Budget Justification

(Only attach one file.)

RESEARCH & RELATED BUDGET - Cumulative Budget

Totals ($)

Section A, Senior/Key Person

Section C, Equipment

Section D, Travel

Domestic

Section E, Participant/Trainee Support Costs

Foreign

Tuition/Fees/Health Insurance

Stipends

Travel

Subsistence

Other

Number of Participants/Trainees

1.

2.

3.

4.

5.

6.

1.

2.

Section F, Other Direct Costs

Materials and Supplies

1.

Publication Costs

2.

Consultant Services

3.

ADP/Computer Services

4.

Subawards/Consortium/Contractual Costs

5.

Equipment or Facility Rental/User Fees

6.

Alterations and Renovations

7.

8.

9.

10.

Total Number Other Personnel

Total Salary, Wages and Fringe Benefits (A+B)

Other 1

Other 2

Other 3

Section B, Other Personnel

Section J, Fee

Section I, Total Direct and Indirect Costs (G + H)

Section H, Indirect Costs

Section G, Direct Costs (A thru F)

Section K, Total Costs and Fee (I + J)

Budget Type is required.

Mandatory:

XDPFirstField:

cbSubaward:

ORGANIZATIONAL DUNS: This is the DUNS or DUNS+4 number of the applicant organization. For the project applicant, this field is prepopulated from the R&R SF424 Cover Page. For subaward applicants, this field is a required enterable field.:

Budget Type - Project, Subaward/Consortium: Check the appropriate block.

Project: The budget requested for the primary applicant organization.:

Budget Type - Project, Subaward/Consortium: Check the appropriate block.

Subaward/Consortium: The budget requested for subawardee/consortium organization(s). Note, separate budgets are required only for subawardee/consortium organizations that perform a substantive portion of the project.

If creating Subaward Budget, use the R&R Subaward Budget Attachment and attach as a separate file on the R&R Budget Attachment(s) form. :

Organization: Pre-populated from the R&R SF424. Enter name of the organization.:

Budget Period Start Date: Enter the requested/proposed start date of each budget period. This field is required.:

Budget Period End Date: Enter the requested/proposed end date of each budget period. This field is required.:

Delete Entry:

Check Form for Errors Button: Click here to check form for errors.:

Save Button: Click here to save the form.:

budgetPeriod1:

budgetperiod2:

no1:

no2:

hiddenNo:

Delete Period: Click here to delete this budget year.:

Next Period: Click here to view the next year.:

Previous Period: Click here to view the previous year.:

Delete Entry:

Prefix: Enter the prefix (e.g., Mr., Mrs., Rev.) for the name of each Senior/Key Person.:

First Name: Enter the first name of the Senior/Key Person. :

Middle Name: Enter the middle name of the Senior/Key Person.:

Last Name: Enter the last (family) name of the Senior/Key Person. :

Suffix: Enter the suffix (e.g., Jr, Sr, PhD) for the name of the Senior/Key Person.:

Base Salary (Senior/Key Person): Enter the annual compensation paid by the employer for each senior/key personnel. This includes all activities such as research, teaching, patient care, or other. You may choose to leave this column blank. :

Calendar Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Academic Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Summer Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Requested Salary (Other Personnel): Regardless of the number of months being devoted to the project, indicate only the amount of salary/wages being requested for each project role.:

Fringe Benefits (Other Personnel):

Enter applicable fringe benefits, if any, for this project role category.:

Indirect Costs Funds Requested: Enter funds requested for each indirect cost type.:

DataEntered:

Additional Project Role Description:

List any additional project role(s) in the blank(s) provided, e.g., Engineer, IT Professionals, etc.:

Next:

Budget Justification: Use the budget justification to provide the additional information requested in each budget category identified above and any other information the applicant wishes to submit to support the budget request. The following budget categories must be justified, where applicable: equipment, travel, participant/trainee support and other direct cost categories. Only one file may be attached. This field is required.:

Budget Justification - Add Attachment: Click this button to add an attachment. Use the budget justification to provide the additional information requested in each budget category identified above and any other information the applicant wishes to submit to support the budget request. The following budget categories must be justified, where applicable: equipment, travel, participant/trainee support and other direct cost categories. Only one file may be attached. This field is required.:

Budget Justification - Delete Attachment: Click here to delete this attachment.:

Budget Justification - View Attachment: Click here to view this attachment.:

Total Funds requested for all Senior Key Persons in the attached file: Enter the total funds requested for all additional senior/key persons. This is required information.:

Total Senior/Key Person: Total funds requested for all Senior Key Persons.:

FileName:

MimeType:

href:

hashAlgorithm:

HashValue_data:

Number of Personnel Post Doctoral Associates: For each project role category identify the number of personnel proposed. :

Calendar Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Academic Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Summer Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Requested Salary (Other Personnel): Regardless of the number of months being devoted to the project, indicate only the amount of salary/wages being requested for each project role.:

Fringe Benefits (Other Personnel):

Enter applicable fringe benefits, if any, for this project role category.:

Funds Requested (Other Personnel): Enter requested salary/wages & fringe benefits for each project role.:

b_1:

Calendar Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Academic Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Summer Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Requested Salary (Other Personnel): Regardless of the number of months being devoted to the project, indicate only the amount of salary/wages being requested for each project role.:

Fringe Benefits (Other Personnel):

Enter applicable fringe benefits, if any, for this project role category.:

Funds Requested (Other Personnel): Enter requested salary/wages & fringe benefits for each project role.:

Number of Personnel Graduate Students:

For each project role category identify the number of personnel proposed. :

b_2:

Calendar Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Academic Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Summer Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Requested Salary (Other Personnel): Regardless of the number of months being devoted to the project, indicate only the amount of salary/wages being requested for each project role.:

Fringe Benefits (Other Personnel):

Enter applicable fringe benefits, if any, for this project role category.:

Funds Requested (Other Personnel): Enter requested salary/wages & fringe benefits for each project role.:

Number of Personnel Undergraduate Students:

For each project role category identify the number of personnel proposed. :

b_3:

Calendar Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Academic Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Summer Months (Other Personnel): Identify the number of months devoted to the project in the applicable box for each project role category; i.e., calendar, academic, summer.:

Requested Salary (Other Personnel): Regardless of the number of months being devoted to the project, indicate only the amount of salary/wages being requested for each project role.:

Fringe Benefits (Other Personnel):

Enter applicable fringe benefits, if any, for this project role category.:

Funds Requested (Other Personnel): Enter requested salary/wages & fringe benefits for each project role.:

Number of Personnel Secretarial/Clerical: Enter the number of personnel proposed for this project role category. In most circumstances, the salaries of administrative or clerical staff at educational institutions and nonprofit organizations are included as part of indirect costs. Examples, however, of situations where direct charging of administrative or clerical staff salaries may be appropriate may be found at: http://www.whitehouse.gov/omb/circulars/a021/a21_2004.html#exc. The circumstances for requiring direct charging of these services must be clearly described in the budget justification.:

b_4:

Number of Personnel ADDITIONAL PROJECT ROLE(S):

For each project role category identify the number of personnel proposed. :

Total Number Other Personnel: This total will auto-calculate. Total Number of Personnel.:

Total Other Personnel: Total Funds requested for all Other Personnel.:

Total Salary, Wages, & Fringe Benefits (A & B): Total Funds requested for all Senior Key Persons and all Other Personnel.:

Equipment Item: Equipment is defined as an item of property that has an acquisition cost of $5,000 or more (unless the organization has established lower levels) and an expected service life of more than one year. List each item of equipment separately and justify each in the budget justification section. Allowable items ordinarily will be limited to research equipment and apparatus not already available for the conduct of the work. General-purpose equipment, such as a personal computer, is not eligible for support unless primarily or exclusively used in the actual conduct of scientific research.:

Total Equipment: Total Funds requested for all equipment.:

Total funds requested for all equipment listed in the attached file: Total funds requested for all equipment listed in the attached file. Dollar amount for item should exceed $5000.:

Domestic Travel Costs: Identify the total funds requested for domestic travel. Domestic travel includes Canada, Mexico and US Possessions. In the budget justification section, include purpose, destination, dates of travel (if known) and number of individuals for each trip. If the dates of travel are not known, specify estimated length of trip (e.g., 3 days).:

Foreign Travel Costs: Identify the total funds requested for foreign travel. Foreign travel includes any travel outside of North America and/or US Possessions. In the budget justification section, include purpose, destination, dates of travel (if known) and number of individuals for each trip. If the dates of travel are not known, specify estimated length of trip (e.g., 3 days).:

Total Travel Cost: Total Funds requested for all travel.:

Participant/Trainee Tuition/Fees/Health Insurance: List total funds requested for Participant/Trainee Tuition/Fees/Health Insurance.:

Participant/Trainee Stipends: List total funds requested for Participant/Trainee Stipends.:

Participant/Trainee Travel: List total funds requested for Participant/Trainee Travel.:

Participant/Trainee Subsistence: List total funds requested for Participant/Trainee Subsistence.:

Other Participant/Trainee Costs (Specify): Describe any other participant trainee funds requested.:

Other Participant/Trainee Costs: List total funds requested for any other Participant/Trainee costs described.:

Number of Participants/Trainees: List total number of proposed participant/trainees, value cannot be greater than 9999.:

Total Participant/Trainee Costs:

Total funds requested for all trainee costs. This field is required if any data has been entered in section E.:

1. Materials and Supplies: List total funds requested for materials & supplies. In the budget justification, indicate general categories such as glassware, chemicals, animal costs, including an amount for each category. Categories less than $1,000 are not required to be itemized.:

2. Publication Costs: List the total publication funds requested. The proposal budget may request funds for the costs of documenting, preparing, publishing or otherwise making available to others the findings and products of the work conducted under the award. In the budget justification include supporting information.:

3. Consultant Services: List the total costs for all consultant services. In the budget justification, identify each consultant, the services he/she will perform, total number of days, travel costs, and total estimated costs. :

4. ADP/Computer Services: List total funds requested for ADP/Computer Services. The cost of computer services, including computer-based retrieval of scientific, technical and education information may be requested. In the budget justification, include the established computer service rates at the proposing organization if applicable. :

5. Subawards/Consortium/Contractual Costs: List total funds requested for 1) all subaward/consortium organization(s) proposed for the project and 2) any other contractual costs proposed for the project.:

6. Equipment or Facility Rental/User Fees: List total funds requested for Equipment or Facility Rental/User Fees. In the budget justification, identify each rental user fee and justify.:

7. Alterations and Renovations: List total funds requested for Alterations & Renovations. In the budget justification, itemize, by category and justify the costs of alterations and renovations including repairs, painting, removal or installation of partitions, shielding, or air conditioning. Where applicable, provide the square footage and costs. :

"Other" (Specify): Add text to describe any "other" Direct Costs not requested above. Use the budget justification to further itemize and justify.:

"Other" Funds Requested: List total funds requested for items 8-10 "Other.":

"Other" (Specify): Add text to describe any "other" Direct Costs not requested above. Use the budget justification to further itemize and justify.:

"Other" Funds Requested: List total funds requested for items 8-10 "Other.":

"Other" (Specify): Add text to describe any "other" Direct Costs not requested above. Use the budget justification to further itemize and justify.:

"Other" Funds Requested: List total funds requested for items 8-10 "Other.":

Total Other Direct Costs: Total Funds requested for all other direct costs.:

Total Direct Costs (A -F): Total Funds requested for all direct costs.:

Indirect Cost Type: Indicate the type of base; e.g., Salary & Wages, Modified Total Direct Costs, Other (explain). Also indicate if Off-site. If more than one rate/base is involved, use separate lines for each. If you do not have a current indirect rate(s) approved by a Federal agency, indicate "None--will negotiate" and include information for a proposed rate. Use the budget justification if additional space is needed.:

Indirect Cost Rate (%): Indicate the most recent Indirect Cost rate(s) (also known as Facilities & Administrative Costs [F&A]) established with the cognizant Federal office, or in the case of for-profit organizations, the rate(s) established with the appropriate agency. If you have a cognizant/ oversight agency and are selected for an award, you must submit your indirect rate proposal to that office for approval. If you do not have a cognizant/oversight agency, contact the awarding agency.:

Indirect Cost Base ($): Enter the amount of the base for each indirect cost type.:

Indirect Costs: Total Funds requested for indirect costs.:

Cognizant Agency (Agency Name, POC Name and Phone Number): Enter the name of the cognizant Federal Agency, name & phone number of the individual responsible for negotiating your rate. If no cognizant agency is known, enter "None".:

Total Direct and Indirect Costs (G & H): Total Funds requested for direct and indirect costs.:

Fee: Generally, a fee is not allowed on a grant or cooperative agreement. Do not include a fee in your budget, unless the program announcement specifically allows the inclusion of a "fee" (e.g., SBIR/STTR). If a fee is allowable, enter the requested fee.:

Total Costs and Fee (I + J): Total Funds requested for direct and indirect costs plus fee. :

Next Period: Click here to view the next year.:

Add Period: Click here to add another budget period.:

AboutButton:

Section A, Senior/Key Person: Cumulative Total Funds requested for all Senior Key Persons.:

Section B, Other Personnel: Cumulative Total Funds requested for all Other Personnel.:

Total Number Other Personnel: The cumulative total number of other Personnel.:

Total Salary, Wages, & Fringe Benefits(A & B): Cumulative Total Funds requested for all Senior Key Persons and all Other Personnel.:

Section C, Equipment: Cumulative Total Funds requested for all equipment.:

Section D, Travel: Cumulative Total Funds requested for all travel.:

Domestic Travel Costs: The cumulative total funds requested for domestic travel.:

Foreign Travel Costs: The cumulative total funds requested for foreign travel.:

Section E, Participant/Trainee Support Costs: The cumulative total funds requested for all trainee costs.:

Participant/Trainee Tuition/Fees/Health Insurance: The cumulative total funds requested for Participant/Trainee Tuition/Fees/Health Insurance.:

Participant/Trainee Stipends: The cumulative total funds requested for Participant/Trainee Stipends.:

Participant/Trainee Travel: The cumulative total funds requested for Participant/Trainee Travel.:

Participant/Trainee Subsistence: The cumulative total funds requested for Participant/Trainee Subsistence.:

Other Participant/Trainee Costs: The cumulative total funds requested for any other Participant/Trainee costs described.:

Number of Participants/Trainees: The cumulative total number of proposed participant/trainees, value cannot be greater than 9999.:

Section F, Other Direct Costs: The cumulative total funds requested for all other direct costs.:

Materials and Supplies: The cumulative total funds requested for materials & supplies.:

Publication Costs: The cumulative total publication funds requested.:

Consultant Services: The cumulative total costs for all consultant services.:

ADP/Computer Services: The cumulative total funds requested for ADP/Computer Services.:

Subaward/Consortium/Contractual Costs: The cumulative total funds requested for 1) all subaward/consortium organization(s) proposed for the project and 2) any other contractual costs proposed for the project.:

Equipment or Facility Rental/User Fees: The cumulative total funds requested for Equipment or Facility Rental/Use Fees.:

Alterations and Renovations: The cumulative total funds requested for Alterations & Renovations.:

Other1: The cumulative total funds requested in line 8 or the first Other Direct Cost Category.:

Other2: The cumulative total funds requested in line 9 or the second Other Direct Cost Category.:

Other3: The cumulative total funds requested in line 10 or the third Other Direct Cost Category.:

Section G, Total Direct Costs (A -F): The cumulative total funds requested for all direct costs.:

Section H, Total Indirect Costs: Cumulative Total Funds requested for indirect costs.:

Section I, Total Direct and Indirect Institutional Costs (G - H): The cumulative total funds requested for direct and indirect costs.:

Section J, Fee: The cumulative total funds requested for fees.:

Section K, Total Costs and Fee (I + J): The cumulative total funds requested for direct and indirect costs plus fee.:

LastField:

Submission D:20061219143208- 05'00' D:20061219143305- 05'00' Grant Application Package Grants.gov Grant Application Package Grants.gov CFDA Number:

Opportunity Title:

Offering Agency:

Agency Contact:

Opportunity Open Date:

Opportunity Close Date:

CFDA Description:

Opportunity Number:

Competition ID:

Application Filing Name:

Select Forms to Complete Mandatory Optional Instructions About the Application Package.

· This application package is used to apply for the specific Federal funding opportunity referenced in this application package. Please verify that you have downloaded and completed the application package for the correct funding opportunity announcement.

· This application can be completed in its entirety offline using Adobe Reader.

· You can save your application at any time by clicking the "Save" button at the top of your screen.

Using the Application Package.

· The application package is a compilation of forms, such as the SF-424, budget forms, attachment forms, and narratives.

· It is recommended that the SF-424 cover page be the first form completed for the application package. Some data entered on the SF-424 cover page will pre-populate data fields in other subsequent forms in the application package.

· Forms identified as Mandatory are required to be filled out to successfully submit your grant application at a minimum. Optional Forms are used to provide additional support for this application or may be required for specific types of grant activity. Reference the application package instructions for more information regarding Optional Forms.

· Select the check box next to the form's name to add the form to the application package. To navigate to the form in the application package, click on the underlined form name. To remove a form from the application package, uncheck the box next to the form name.

· When you open a form, required fields are highlighted in yellow with a red border. Optional fields and completed fields are displayed in white. If you enter invalid or incomplete information in a field, you will receive an error message.

· Your application will be rejected if you do not follow the Agency and Grants.gov guidance on file naming conventions. Please review the application instructions for this Opportunity Package for specific guidelines and refer to FAQs in the Grants.gov Applicants tab.

Submitting the Application Package.

· You can save the application as you work on it by clicking on the "Save" button.

· Click on the "Check Package for Errors" button to ensure that you have completed all required data fields. Correct any errors. If no errors are found, save the application package. The "Save & Submit" button will also become active.

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· Click on the "Save & Submit" button to begin the application submission process. (You must be connected to the Internet at this time.) You will be taken to the applicant login page to enter your Grants.gov username and password. Follow all onscreen instructions for submission. Upon submission, you will be provided with a Grants.gov Tracking Number.

· You will receive a series of emails after submission: 1. Successful transmission to Grants.gov and your application is undergoing a series of system checks, 2. An email either indicating specific errors in your application OR an email indicating that your submission is being prepared for agency download, and 3. Your application has been retrieved from Grants.gov by the funding agency for further review only after the agency acknowledges the download. If you receive an email with an error, please correct your application and resubmit.

Additional Application Package Information.

· Additional instructions and FAQs about the Application Package can be found in the Grants.gov Applicants tab.

This electronic grants application is intended to be used to apply for the specific Federal funding opportunity referenced here.

If the Federal funding opportunity listed is not the opportunity for which you want to apply, close this application package by clicking on the "Cancel" button at the top of this screen. You will then need to locate the correct Federal funding opportunity, download its application and then apply.

Name- Version Form Tag Name Mandatory Name- Version Form Tag Name Optional Name- Version Form Tag Name SelectedOptional Name- Version Form Tag Name SelectedMandatory Grant Application Package Grants.gov Grant Application Package Grants.gov

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http://www.grants.gov/web/grants/applicants/applicant-faqs.html Also the Grants.gov Contact Center is available for further assistance. The Contact Center is available 24 hours a day, 7 days a week excluding federal holidays.

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Install the required version and try again.

To download the Grants.gov required version visit:

http://www.grants.gov/web/grants/applicants/adobe-software-compatibility.html For more information:

http://www.grants.gov/web/grants/applicants/applicant-faqs.html Also the Grants.gov Contact Center is available for further assistance. The Contact Center is available 24 hours a day, 7 days a week excluding federal holidays.

Email: support@grants.gov Phone: 1-800-518-4726 (local toll free). For international callers, please dial 1-606-545-5035 to speak with a Contact Center representative.

State Application Identifier Applicant Identifier

1. TYPE OF SUBMISSION

4. a. Federal Identifier

5. APPLICANT INFORMATION

Organizational DUNS:

Legal Name:

Department:

Division:

Street1:

Street2:

City:

State:

ZIP / Postal Code:

Country:

Person to be contacted on matters involving this application First Name:

Middle Name:

Last Name:

Suffix:

Phone Number:

Fax Number:

Email:

6. EMPLOYER IDENTIFICATION (EIN) or (TIN):

7. TYPE OF APPLICANT:

Other (Specify):

Women Owned Socially and Economically Disadvantaged Small Business Organization Type If Revision, mark appropriate box(es).

9. NAME OF FEDERAL AGENCY:

A. Increase Award B. Decrease Award C. Increase Duration D. Decrease Duration E. Other (specify):

10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:

Is this application being submitted to other agencies?

TITLE:

11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:

2. DATE SUBMITTED

3. DATE RECEIVED BY STATE

APPLICATION FOR FEDERAL ASSISTANCESF 424 (R&R)

County / Parish:

Province:

Prefix:

What other Agencies?

TYPE OF SUBMISSION is required: If this submission is to change or correct a previously submitted "New", "Resubmission", "Renewal", "Continuation", or "Revision" application, click the Changed/Corrected Application box and enter the Grants.gov tracking number in the Previous Grants.gov Tracking ID field. Unless requested by the agency, applicants may not use this to submit changes after the closing date.

Is this application being submitted to other agencies: Check box if applicable.

This field is required.

Is this application being submitted to other agencies is required.

8. TYPE OF APPLICATION:

OMB Number: 4040-0001 Expiration Date: 10/31/2019

b. Agency Routing Identifier

12. PROPOSED PROJECT:

Start Date Ending Date

13. CONGRESSIONAL DISTRICT OF APPLICANT

c. Previous Grants.gov Tracking ID Country:

Position/Title:

Province:

County / Parish:

State:

City:

Street2:

Street1:

ZIP / Postal Code:

APPLICATION FOR FEDERAL ASSISTANCE

SF 424 (R&R)

15. ESTIMATED PROJECT FUNDING

a. Total Federal Funds Requested

17. By signing this application, I certify (1) to the statements contained in the list of certifications* and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances * and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious. or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)

19. Authorized Representative First Name:

Middle Name:

Last Name:

Suffix:

Position/Title:

Organization:

Department:

Division:

Street1:

Street2:

City:

State:

ZIP / Postal Code:

Country:

Phone Number:

Fax Number:

Email:

Signature of Authorized Representative Date Signed

20. Pre-application *The list of certifications and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

County / Parish:

c. Total Federal & Non-Federal Funds

18. SFLLL (Disclosure of Lobbying Activities) or other Explanatory Documentation Province:

b. Total Non-Federal Funds Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Position/Title:

Organization Name:

Department:

Division:

Street1:

Street2:

City:

ZIP / Postal Code:

Country:

Phone Number:

Fax Number:

Email:

State:

County / Parish:

Province:

Prefix:

16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?

DATE:

THIS PREAPPLICATION/APPLICATION WAS MADE

AVAILABLE TO THE STATE EXECUTIVE ORDER 12372

PROCESS FOR REVIEW ON:

PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW

PROGRAM IS NOT COVERED BY E.O. 12372; OR

d. Estimated Program Income

21. Cover Letter Attachment

14. PROJECT DIRECTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION

ATTACHMENTS FORM

Instructions: On this form, you will attach the various files that make up your grant application. Please consult with the appropriate Agency Guidelines for more information about each needed file. Please remember that any files you attach must be in the document format and named as specified in the Guidelines.

Instructions: On this form, you will attach the various files that make up your grant application. Please consult with the appropriate Agency Guidelines for more information about each needed file. Please remember that any files you attach must be in the document format and named as specified in the Guidelines.

15) Please attach Attachment 15

1) Please attach Attachment 1

2) Please attach Attachment 2

3) Please attach Attachment 3

4) Please attach Attachment 4

5) Please attach Attachment 5

6) Please attach Attachment 6

7) Please attach Attachment 7

8) Please attach Attachment 8

9) Please attach Attachment 9

10) Please attach Attachment 10

11) Please attach Attachment 11

12) Please attach Attachment 12

13) Please attach Attachment 13

14) Please attach Attachment 14 Important: Please attach your files in the proper sequence. See the appropriate Agency Guidelines for details.

Important: Please attach your files in the proper sequence. See the appropriate Agency Guidelines for details.

Budget Type:

Enter name of Organization:

Start Date:

End Date:

ORGANIZATIONAL DUNS:

OMB Number: 4040-0001 Expiration Date: 10/31/2019 A. Senior/Key Person Prefix First Middle Last Suffix Base Salary ($) Months Cal.

Acad.

Sum.

Requested Salary ($) Fringe Benefits ($) Funds Requested ($) Project Role:

Additional Senior Key Persons:

Total Funds requested for all Senior Key Persons in the attached file Total Senior/Key Person B. Other Personnel Number of Personnel Project Role Funds Requested ($) Fringe Benefits ($) Requested Salary ($) Sum.

Acad.

Cal.

Months Post Doctoral Associates Graduate Students Undergraduate Students Secretarial/Clerical Total Number Other Personnel Total Other Personnel Total Salary, Wages and Fringe Benefits (A+B) C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment item Funds Requested ($) Total funds requested for all equipment listed in the attached file Total Equipment Additional Equipment:

D. Travel Domestic Travel Costs ( Incl. Canada, Mexico and U.S. Possessions) 1.

Foreign Travel Costs 2.

Total Travel Cost Funds Requested ($) E. Participant/Trainee Support Costs Tuition/Fees/Health Insurance 1.

Stipends 2.

Travel 3.

Subsistence 4.

Other 5.

Funds Requested ($) Number of Participants/Trainees Total Participant/Trainee Support Costs F. Other Direct Costs Funds Requested ($) 1.

Materials and Supplies 2.

Publication Costs 3.

Consultant Services 4.

ADP/Computer Services 5.

Subawards/Consortium/Contractual Costs 6.

Equipment or Facility Rental/User Fees 7.

Alterations and Renovations 8.

9.

10.

Total Other Direct Costs G. Direct Costs Funds Requested ($) Total Direct Costs (A thru F) H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($) Total Indirect Costs Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) I. Total Direct and Indirect Costs Funds Requested ($) Total Direct and Indirect Institutional Costs (G + H) J. Fee Funds Requested ($) K. Total Costs and Fee Funds Requested ($) Total Costs and Fee (I + J) L. Budget Justification (Only attach one file.)

Section A, Senior/Key Person Section C, Equipment RESEARCH & RELATED BUDGET - Cumulative Budget Section D, Travel Domestic Section E, Participant/Trainee Support Costs Foreign Tuition/Fees/Health Insurance Stipends Travel Subsistence Other Number of Participants/Trainees 1.

2.

3.

4.

5.

6.

1.

2.

Section F, Other Direct Costs Materials and Supplies 1.

Publication Costs 2.

Consultant Services 3.

ADP/Computer Services 4.

Subawards/Consortium/Contractual Costs 5.

Equipment or Facility Rental/User Fees 6.

Alterations and Renovations 7.

8.

9.

10.

Totals ($) Total Number Other Personnel Total Salary, Wages and Fringe Benefits (A+B) Other 1 Other 2 Other 3 Section B, Other Personnel Section J, Fee Section I, Total Direct and Indirect Costs (G + H) Section H, Indirect Costs Section G, Direct Costs (A thru F) Budget Type is required.

Section K, Total Costs and Fee (I + J)

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:$

* Street 1

* City State Zip Street 2

* Last Name Prefix

* First Name Middle Name Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 Approved by OMB 4040-0013

1. * Type of Federal Action:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Type of Federal Action is required: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. * Status of Federal Action:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action is required: Identify the status of the covered Federal action.

3. * Report Type:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Reporting Entity: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. This field is required.

Reporting Entity is required: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

Tier if known:

* Name

* Street 1 Street 2

* City State Zip Congressional District, if known:

Congressional District, if known:

* Name

* City State

* Street 1 Street 2 Zip

6. * Federal Department/Agency:

7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a) Prefix

* First Name Middle Name

* Street 1

* City State Zip Street 2 11.

* Last Name Suffix Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* Signature:

*Name:

Prefix

* First Name Middle Name

* Last Name Suffix Title:

Telephone No.:

Date:

Federal Use Only:

Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

R&R SUBAWARD BUDGET ATTACHMENT(S) FORM

Instructions: On this form, you will attach the R&R Subaward Budget files for your grant application. Complete the subawardee budget(s) in accordance with the R&R budget instructions. Please remember that any files you attach must be a PDF document.

Important: Please attach your subawardee budget file(s) with the file name of the subawardee organization. Each file name must be unique.

OMB Number: 4040-0001 Expiration Date: 10/31/2019

1) Please attach Attachment 1

2) Please attach Attachment 2

3) Please attach Attachment 3

4) Please attach Attachment 4

5) Please attach Attachment 5

6) Please attach Attachment 6

7) Please attach Attachment 7

8) Please attach Attachment 8

9) Please attach Attachment 9

10) Please attach Attachment 10

R&R SUBAWARD BUDGET ATTACHMENT(S) FORM

Workspace Use Only

When the Workspace feature is used to complete application packages, subforms are added and managed using online Workspace functionality. This Workspace variation of the R&R Subaward Budget Attachment(s) form displays subform names as specified by the applicant:

OMB Number: 4040-0001 Expiration Date: 10/31/2019

1) R&R Subaward Budget 1

2) R&R Subaward Budget 2

3) R&R Subaward Budget 3

4) R&R Subaward Budget 4

5) R&R Subaward Budget 5

6) R&R Subaward Budget 6

7) R&R Subaward Budget 7

8) R&R Subaward Budget 8

9) R&R Subaward Budget 9

10) R&R Subaward Budget 10 Budget Type:

Enter name of Organization:

Start Date:

End Date:

ORGANIZATIONAL DUNS:

Budget Type is required.

OMB Number: 4040-0001 Expiration Date: 10/31/2019 A. Senior/Key Person Prefix First Middle Last Suffix Base Salary ($) Months Cal.

Acad.

Sum.

Requested Salary ($) Fringe Benefits ($) Funds Requested ($) Project Role:

Additional Senior Key Persons:

Total Funds requested for all Senior Key Persons in the attached file Total Senior/Key Person B. Other Personnel Number of Personnel Project Role Funds Requested ($) Fringe Benefits ($) Requested Salary ($) Sum.

Acad.

Cal.

Months Post Doctoral Associates Graduate Students Undergraduate Students Secretarial/Clerical Total Number Other Personnel Total Other Personnel Total Salary, Wages and Fringe Benefits (A+B) C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment item Funds Requested ($) Total funds requested for all equipment listed in the attached file Total Equipment Additional Equipment:

D. Travel Domestic Travel Costs ( Incl. Canada, Mexico and U.S. Possessions) 1.

Foreign Travel Costs 2.

Total Travel Cost Funds Requested ($) E. Participant/Trainee Support Costs Tuition/Fees/Health Insurance 1.

Stipends 2.

Travel 3.

Subsistence 4.

Other 5.

Funds Requested ($) Number of Participants/Trainees Total Participant/Trainee Support Costs F. Other Direct Costs Funds Requested ($) 1.

Materials and Supplies 2.

Publication Costs 3.

Consultant Services 4.

ADP/Computer Services 5.

Subawards/Consortium/Contractual Costs 6.

Equipment or Facility Rental/User Fees 7.

Alterations and Renovations 8.

9.

10.

Total Other Direct Costs G. Direct Costs Funds Requested ($) Total Direct Costs (A thru F) H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($) Total Indirect Costs Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) I. Total Direct and Indirect Costs Funds Requested ($) Total Direct and Indirect Institutional Costs (G + H) J. Fee Funds Requested ($) K. Total Costs and Fee Funds Requested ($) Total Costs and Fee (I + J) L. Budget Justification (Only attach one file.)

Section A, Senior/Key Person Section C, Equipment RESEARCH & RELATED BUDGET - Cumulative Budget Section D, Travel Domestic Section E, Participant/Trainee Support Costs Foreign Tuition/Fees/Health Insurance Stipends Travel Subsistence Other Number of Participants/Trainees 1.

2.

3.

4.

5.

6.

1.

2.

Section F, Other Direct Costs Materials and Supplies 1.

Publication Costs 2.

Consultant Services 3.

ADP/Computer Services 4.

Subawards/Consortium/Contractual Costs 5.

Equipment or Facility Rental/User Fees 6.

Alterations and Renovations 7.

8.

9.

10.

Totals ($) Total Number Other Personnel Total Salary, Wages and Fringe Benefits (A+B) Other 1 Other 2 Other 3 Section B, Other Personnel Section J, Fee Section I, Total Direct and Indirect Costs (G + H) Section H, Indirect Costs Section G, Direct Costs (A thru F) Budget Type is required.

Section K, Total Costs and Fee (I + J)